Michael J. Marrrero - Elliot Kalus.• ~ City of I~liamr Beach Office ~of:the .City Clerk ~~.
1700 Convention, CenterDrive, ivli•al~ni Beach, FL 33-:139 .
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,, .. LOBBY~S'I' REGISTRATION FORM .. -
Lobbyist'.meaos all .persons employed or retained, whether paid~or not,. by a :principal who seeks Ito encourage the .passage, defeat
' or modifcation of .any ordinance, r-esolufion, .action-or decision of any commissioner, any action, decision, recommendation of the
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Ceriod of the ent any. city board or committee• or any action, decision or recommendation of any city personnel during the time
• •- p ire decision-making process on such action,'decision or recommendation.. that foreseeably will 'tie heard or reviewed
by the city commission, or a city board or committee.. The term specifically includes the principal as well as any employee engaged
• •- in .lobbying. activities.. The.. term. "Lobbyists" has specific exclusions. Please .refer to Ordinance 2004-3..435.
;,
• Marrero Michael ~ ~ J.
NAME OF .LOBBYIST:. (Last) f . (First)
. _ (M.I)
. ~ ,
Bercow, Radell & Fernandez, P.A. 200 S. Biscayne. Blvd., .Suite 850 Miami ~ . ~~ Florida 33131 ~ `
' ~ BUSINESS NAME AND ADDRESS ~ (Number and Street) ~. .~ , (City) (State) (Zip Code)
(3051 377-6238.._ 13051.377=6222 mmarreroCa~brzoninglaw com
' ~ TELEPHONE NUMBER: FAX NUMBER: EMAIL: .
` I. ~. LOBBYIST RETAINED BY: `
.. .=~. _ .
• Elliot Kalus _
,, NAME OF PRINCIPAL/CLIENT:- - ;
. ,
Hebrew Homes Health Network 1800 NE 168 Street ' 2"d Floor Miami Florida 33162
°: .BUSINESS NAME AND ADDRESS
(Number and. Street); ~- (City). (State) (Zip:Code)
(305) 917-0407 ~ ~ ~ j . (305) 917-0410 .. .
.. ,
` ~ TELEPHONE NUMBER: FAX NUMBER: {Optional) EMAIL: (Optional)
• II. - SPECIFIC. LOBBY ISSUE: ". ~ `
HPB Approval at 302-310 Collins Avenue .
Issue to be lobbied. (Describe in detail):
III. CITY AGENCIES/INDIVIDUALS TO $E LOBBIED:
4 •• .
A) Full Name of Individual/Title B) Any Financial, familial.or Professional Relationshi
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• Historic Preservation Board - . ^ ~ .None ~~ ~~ ~ .'~ ~~ ~ ~ ~ 8~~ ~~~ ~ `~ ~:,~. ~. !' ~1
Planning .Department Staff`... •
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•: None ~ ~:..
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE. WHETHER HOURLY,
FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required) $ 300.00 per hour.
B) PRINCIPAL'S DISCLOSURE {OF LOBBYIST COMPENSATION): (Required). $ 300.00 per hour
The. following information must be answered:
1) Pursuant to Miami .Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists
On Procurement Issues":
^ Yes X No: Are v®u lobbving on a present or pending bid for goods, equipment or services, or on a
present or pending award for goods, equipment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled ~~Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
^Yes X No: Are you lobbvina on a pending application for a Development Agreement with the City or
application for change of zoning map designation or change to the City's Future Land Use
Map?
3) Pursuant to Miami Beach City Code 2-484 (h) Any person (except those exempt from the definition of
"lobbyist" as set forth in Section 2-481 above) who only appears as a representative of snot-for-profit
corporation or entity without special compensation or reimbursement for the appearance, whether direct, or
indirect, to express support of or opposition to any -item, shall register with the clerk as required by this
section but, shall not be required to pay any registration fees..
^ .Yes X No: Are you representinu anot-for-profit corporation or entity without special compensation
or reimbursement. ~ •
V. SIGNATURE UNDER OATH:
ON OCTOBER 1ST' OF :.EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, LISTING . LOBBYING EXPENDITURES, AS WELL AS COMPENSATION
RECEIVED, IN THE CITY Of MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT
SHALL B'E FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE
REPORTING PERIOD. ~ /)/1
Signature ofd To byist
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I do solemnly swear that all of the foregoing facts are true and correct and that I have read or am
familiar with the provisions contained in Se ~' n 2-482 of the Miami Beach City Code and all reporting-
requirements. ~1 ^ ~~~
Signature of Lobbyist:
Signature. of Principal/Clien
VI. LOBBYIST YDE TYFICATION:
^ Produced ID .
Form.. of Identification
Personal) known Lobb ist
Y ( Y )
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade,
Sworn to .and. subscribed before me •
This l~ad~y ~ , 201
Sign~ture ~bl(c Notary -State of Florida
Notarization of Lobbyist's signature
PRINCIPAL IDENTIFICATION:
^ Produced ID ~..~'":~'H•.,
Form of Identification
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personally known (Principal) ,
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State of Florida, County of. Miami-Dade _
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Sworn and subscribed before me ~
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This L1. day of , 20/V -
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Signature f Pub c otary -State of Florida
Notariz ion o rincipal's signature
FOR CLERK'S E ONLY
Annuai Registration fee: ]Yes [ ] No Amou Paid ~~ CR # ~ Date PaidS_
Lobbyist Registration Form received and verified b Entered By:
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM OS.doc
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Revised 12/08/04
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City o¢ Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK Office.
Tel: 305.673.741 1 ,Fax: 305.673.7254
CityClerk@miamibeachfl.gov
Acknowledgement of fines/suspension from lobbying for failure to
.comply with City of -Miami Beach lobbying laws
LOBBYIST NAME: ~ ~ ~"' G~ L ~, ` ~Y~~ra
I understand that no later than October 1st of each year, lobbyists subject to lobbyist
registration requirements shall submit to the city clerk a signed statement under oath
listing .all -lobbying expenditures, as well as compensation received, for the preceding
calendar year with regard to the specific issue on which the lobbyist has been engaged
to lobby. A statement shall be filed even if there .have been no expenditures or
compensation during the reporting period. The statement shall list, in detail, each
expenditure by category, including food and beverage, entertainment, research,,
communication, media advertising, publications, travel, lodging and special events.
Failure to timely file the expenditure and fee disclosure report will result
in :a fine of $50.00 per day. Any lobbyist who fails to file the required
expenditure report by December 1, shall automatically be suspended
from -lobbying until all fines are paid, unless the #ine has been appealed
to the .Miami-Dade County Commission on Ethics and Public- Trust. In the
event a lobbyist fails to either file the report and/or pay the assessed fines, the Clerk shall
notify the Miami-.Dade County Commission on Ethics and Public Trust.
In addition, once an issue I have registered to lobby on has been resolved, I am required
to immediately notify the City Clerk's Office of lobbyist withdrawal in writing.
I1 ~b
Signature: ate: